Contributos da intervenção de enfermagem na promoção da transição para a maternidade e do aleitamento materno : um estudo quasi-experimental

Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem, 2011A gravidez e o pós-parto são caracterizados por grandes desafios e mudanças, com consequentes reajustamentos físicos, psicológicos, familiares e sociais. Os profissionais de saúde, através dos cuidados que prestam, constituem-se importantes recursos para ultrapassar com sucesso os desafios face à nova situação. O estudo teve como objectivo analisar os contributos de intervenções de enfermeiras de Centros de Saúde do distrito de Viana do Castelo, na promoção: i) do auto-cuidado e cuidados à criança, ii) da transição para a maternidade, iii) do aleitamento materno. Para tal desenhámos um estudo quasi-experimental, com uma amostra de 151 primíparas, com vigilância da gravidez e de saúde infantil nos Centros de Saúde, distribuídas aleatoriamente por quatro coortes. A variável independente foi a participação num curso de preparação para a parentalidade/parto e uma visita domiciliária no pós-parto. A recolha de dados ocorreu entre a 26ª e a 28ª semanas de gravidez, 28º e 32º dias após o parto e sexto mês após o parto, através de questionário, da escala Maternal Adjustment and Maternal Attitudes, Maternal Self-Report Inventory e Maternal Breastfeeding Evaluation Scale. Os resultados indicaram que os contributos para o auto-cuidado e os cuidados à criança foram elevados, diminuindo da gravidez até ao sexto mês após o parto, não se verificando efeitos decorrentes da intervenção. Na transição para a maternidade, o ajustamento face aos Sintomas Somáticos, e as Atitudes perante a Gravidez e o Bebé evoluiram favoravelmente, enquanto na Imagem Corporal e na Relação Conjugal a evolução foi desfavorável. Não se observaram efeitos decorrentes da intervenção. A auto-estima materna era elevada. O aleitamento materno, apresentou uma taxa de iniciação elevada (97,4%), com quebras acentuadas ao longo do tempo. A taxa de prevalência do aleitamento materno exclusivo ao primeiro mês foi de 41% e aos seis meses de 2%; a de aleitamento materno foi, respectivamente, de 79,9% e 37,1%. A duração média foi de 123,8±68,9 dias, amamentando durante mais tempo as mulheres com intervenção no pré e pós-parto. Em síntese, intervenções que se prolongam no tempo, com diversidade de estratégias e contextos de intervenção, tem efeitos na duração do aleitamento materno, não se verificando nas restantes situações em análise.Pregnancy and postpartum are characterized by great challenges and changes, with major physical, psychological, familial and social adjustments. Health professionals, through the care they provide, are important resources to be successfully overcome the challenges of the new situation. The aim of the study was to analyze the contributions of Primary Health Care nurses interventions, in the district of Viana do Castelo, in promoting: i) self-care and child care, ii) transition to motherhood, iii) breastfeeding. I It was a quasi-experimental study, with a sample of 151 primiparous, randomly distributed for four cohorts, with pregnancy and child health monitoring in health centers, and were. The independent variable was the nursing intervention, that assumed the mode: preparation course for parenting /childbirth, and a home visit. Data collection took place between the 26th and 28th week of pregnancy, 28 and 32 days after birth and sixth month after birth, through a questionnaire, Maternal Adjustment and Maternal Attitudes scale, Maternal Self-Report Inventory and Maternal Breastfeeding Evaluation Scale. The results indicated that the contributions to the self-care and child care was high and decreased from the pregnancy until the sixth month after delivery. There were no effects depending the intervention. It concerns the transition to motherhood, the adjustment of the, Somatic Symptoms, and Attitudes towards the Pregnancy and Baby evolved favorably and adversely it concerns Body Image and the Marital Relationship. There were no effects depending the intervention. The maternal self-esteem was high. The breastfeeding initiation rate was high (97.4%), with sharp falls over time. The prevalence rate of exclusive breastfeeding during the first month was 41% and 2% at six months. The breastfeeding was, respectively, 79.9% and 37.1%. The average length was 123.8 ± 68.9 days. The women with intervention in pre-and post-partum, breastfed for longer. In summary, interventions that extend through time, with diversity of strategies and contexts of intervention has positive effects on breastfeeding duration, that is not observed in the other variables

Contributos da intervenção de enfermagem de cuidados de saúde primários para a promoção do aleitamento materno

This study aimed to analyze the contributions of the Primary Healthcare nursing interventions, with primiparae in the promotion of breastfeeding. This is a quasi-experimental, longitudinal study, with a sample consisting of 151 primiparae, who had less than 28 weeks of pregnancy, with the child living for at least six months after the birth, performed between 15 October 2007 and 29 February 2008. Almost all the women initiated breastfeeding, with a sharp decline verified in the prevalence at six months. The mean duration of breastfeeding was 123.8±68.9 days. The intervention that began in the prepartum and continued into the postpartum period, using various strategies (individual consultation, preparation courses for parenting/childbirth, and domicile visits) and intervention contexts (health services and domicile) had significant effects on the duration of breastfeeding, which was not verified in the prevalence.El presente estudio tuvo como objetivo analizar las contribuciones de las intervenciones de enfermeras de Cuidados de Salud Primarios, con primíparas, en la promoción del amamantamiento materno. Se trata de un estudio casi experimental, longitudinal, con una muestra de 151 primíparas, con menos de 28 semanas de embarazo entre 15 de Octubre de 2.007 y 29 de Febrero de 2.008, con hijos vivos después de seis meses del parto. La casi totalidad de las mujeres inició el amamantamiento materno, verificándose una quiebra acentuada de la prevalencia a los seis meses. La duración promedio del amamantamiento materno fue 123,8±68,9 días. La intervención se inició en el preparto y se prolongó para el posparto, con diversidad de estrategias (consulta individual, curso de preparación para la paternidad/parto, y visita domiciliaria) y contextos de intervención (servicios de salud y domicilio) tuvo efectos significativos en la duración del amamantamiento materno, lo que no fue verificando en la prevalencia.O presente estudo teve como objetivo analisar os contributos das intervenções de enfermeiras de Cuidados de Saúde Primários, com primíparas, na promoção do aleitamento materno. Trata-se de um desenho quase-experimental, longitudinal, com amostra de 151 primíparas, com menos de 28 semanas de gravidez, entre 15 de outubro de 2007 e 29 de fevereiro de 2008, com filhos vivos aos seis meses após o parto. A quase totalidade das mulheres iniciou o aleitamento materno, verificando-se quebra acentuada da prevalência até os seis meses. A duração média do aleitamento materno foi 123,8±68,9 dias. A intervenção que se iniciou no pré-parto e se prolongou para o pós-parto, com diversidade de estratégias (consulta individual; curso de preparação para a parentalidade/parto e visita domiciliária) e contextos de intervenção (serviços de saúde e domicílio), teve efeitos significativos na duração do aleitamento materno, não se verificando na prevalência

Contributos da intervenção de enfermagem de cuidados de saúde primários para a promoção do aleitamento materno

O presente estudo teve como objetivo analisar os contributos das intervenções de enfermeiras de Cuidados de Saúde Primários, com primíparas, na promoção do aleitamento materno. Trata-se de um desenho quase-experimental, longitudinal, com amostra de 151 primíparas, com menos de 28 semanas de gravidez, entre 15 de outubro de 2007 e 29 de fevereiro de 2008, com filhos vivos aos seis meses após o parto. A quase totalidade das mulheres iniciou o aleitamento materno, verificando-se quebra acentuada da prevalência até os seis meses. A duração média do aleitamento materno foi 123,8±68,9 dias. A intervenção que se iniciou no pré-parto e se prolongou para o pós-parto, com diversidade de estratégias (consulta individual; curso de preparação para a parentalidade/parto e visita domiciliária) e contextos de intervenção (serviços de saúde e domicílio), teve efeitos significativos na duração do aleitamento materno, não se verificando na prevalência.This study aimed to analyze the contributions of the Primary Healthcare nursing interventions, with primiparae in the promotion of breastfeeding. This is a quasi-experimental, longitudinal study, with a sample consisting of 151 primiparae, who had less than 28 weeks of pregnancy, with the child living for at least six months after the birth, performed between 15 October 2007 and 29 February 2008. Almost all the women initiated breastfeeding, with a sharp decline verified in the prevalence at six months. The mean duration of breastfeeding was 123.8±68.9 days. The intervention that began in the prepartum and continued into the postpartum period, using various strategies (individual consultation, preparation courses for parenting/childbirth, and domicile visits) and intervention contexts (health services and domicile) had significant effects on the duration of breastfeeding, which was not verified in the prevalence.info:eu-repo/semantics/publishedVersio

SARS-CoV-2 introductions and early dynamics of the epidemic in Portugal

Genomic surveillance of SARS-CoV-2 in Portugal was rapidly implemented by the National Institute of Health in the early stages of the COVID-19 epidemic, in collaboration with more than 50 laboratories distributed nationwide. Methods By applying recent phylodynamic models that allow integration of individual-based travel history, we reconstructed and characterized the spatio-temporal dynamics of SARSCoV-2 introductions and early dissemination in Portugal. Results We detected at least 277 independent SARS-CoV-2 introductions, mostly from European countries (namely the United Kingdom, Spain, France, Italy, and Switzerland), which were consistent with the countries with the highest connectivity with Portugal. Although most introductions were estimated to have occurred during early March 2020, it is likely that SARS-CoV-2 was silently circulating in Portugal throughout February, before the first cases were confirmed. Conclusions Here we conclude that the earlier implementation of measures could have minimized the number of introductions and subsequent virus expansion in Portugal. This study lays the foundation for genomic epidemiology of SARS-CoV-2 in Portugal, and highlights the need for systematic and geographically-representative genomic surveillance.We gratefully acknowledge to Sara Hill and Nuno Faria (University of Oxford) and Joshua Quick and Nick Loman (University of Birmingham) for kindly providing us with the initial sets of Artic Network primers for NGS; Rafael Mamede (MRamirez team, IMM, Lisbon) for developing and sharing a bioinformatics script for sequence curation (https://github.com/rfm-targa/BioinfUtils); Philippe Lemey (KU Leuven) for providing guidance on the implementation of the phylodynamic models; Joshua L. Cherry (National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health) for providing guidance with the subsampling strategies; and all authors, originating and submitting laboratories who have contributed genome data on GISAID (https://www.gisaid.org/) on which part of this research is based. The opinions expressed in this article are those of the authors and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government. This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. Some infrastructural resources used in this study come from the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT).info:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost